Shelly Warren Darty, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

861 Old Winston Rd
Kernersville, NC 27284-7140

Phone

(336) 802-2300

Fax

(336) 802-2301

NPI assigned

Nov 28, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wake Forest Health Network LLC

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1477785756
  Medicare reassignment
• Cornerstone Health Care, PA

  • Obstetrics & Gynecology Physician
  • High Point, NC
  • NPI 1104940923
  NPD
• Wake Forest Health Network, LLC

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1053175299
  NPD
• Cornerstone Health Care PA

  • Cardiovascular Disease Physician
  • Statesville, NC
  • NPI 1275914046
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242604800000",
    "number": "1013990712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 IDOL ST",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272627804",
            "telephone_number": "336-802-2400",
            "fax_number": "336-802-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "861 OLD WINSTON RD",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847140",
            "telephone_number": "336-802-2300",
            "fax_number": "336-802-2301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DARTY",
        "first_name": "SHELLY",
        "middle_name": "WARREN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-28",
        "last_updated": "2009-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "102585",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7057773",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "D7935",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaylee Damsen
• Katy Demanigold Danford, NP-C
• Daniel Max & Marc Andrea LLC
• Kaitlyn Daniel, PHARMD
• Sara Danielle Danser
• James Dasher, MD
• Melissa Stout Davies, DO
• Cecil Manning Davis, PHARM.D
• Krystajah Davis
• Latishia Rae Davis, NCC, LPC

• Physician Assistant in Kernersville, NC
• Providers in Kernersville, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.